Targeted temperature management following cardiac arrest

An update
Recently a randomised trial published in the New England Journal of Medicine compared
the outcomes of cooling patients to 33C with those cooled to 36C. The Targeted
Temperature Management at 33C versus 36C after Cardiac Arrest study enrolled 950
patients and found that survival and neurological outcomes were not statistically different
between the two groups (1). Importantly, there was a strict protocol for prognostication
and withdrawal of life-sustaining treatment.
A key message from this study is that targeted temperature management (TTM) remains
an important component of the post resuscitation care of the unconscious cardiac arrest
patient and that similar results were obtained when either 33C or 36C were selected as
target temperature. As detailed by the study investigators and the authors of the
accompanying editorial (2), this study does not support a treatment strategy where TTM
is abandoned.
This available trial data confirms that good outcomes with no greater risk of adverse
events can be obtained with a strategy that includes TTM at 33C, which is similar to
current treatment recommendations. This trial found similar good outcomes with a new
regimen targeting 36C, and a formal evidence review will need to consider whether this
new TTM regimen should be part of future treatment recommendations. Pending formal
Consensus on the optimal temperature, we suggest that clinicians provide postresuscitation care based on the current treatment recommendations (3,4). We accept that
some clinicians may make a local decision to use a target temperature of 36C pending
this further guidance.
Ian Jacobs
ILCOR Co-Chair

Vinay Nadkarni
ILCOR Co-Chair

17th Dec 2013

(1) Nielsen N, Wetterslev J, Cronberg, T, et al. Targeted Temperature Management at 33C versus 36C after Cardiac Arrest. N Engl
J Med. 2013. DOI:10.1056/NEJMoa1310519
(2) Rittenberger J.C, Callaway CW. Temperature Management and Modern Post-Cardiac Arrest Care . N Engl J Med. 2013;
DOI:10.1056/NEJMe1312700.
(3) Morrison LJ, Deakin CD, Morley PT, Callaway CW, Kerber RE, Kronick SL,Lavonas EJ, Link MS, Neumar RW, Otto CW,
Parr M, Shuster M, Sunde K, Peberdy MA,Tang W, Hoek TL, Bttiger BW, Drajer S, Lim SH, Nolan JP; Advanced Life
SupportChapter Collaborators. Part 8: Advanced life support: 2010 InternationalConsensus on Cardiopulmonary Resuscitation and
Emergency Cardiovascular CareScience With Treatment Recommendations. Circulation. 2010 Oct 19;122(16 Suppl2):S345-421.
(4) Deakin CD, Morrison LJ, Morley PT, Callaway CW, Kerber RE, Kronick SL, Lavonas EJ, Link MS, Neumar RW, Otto CW,
Parr M, Shuster M, Sunde K, Peberdy MA, Tang W, Hoek TL, Bttiger BW, Drajer S, Lim SH, Nolan JP; Advanced Life Support
Chapter Collaborators.Part 8: Advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care Science with Treatment Recommendations.Resuscitation. 2010 Oct;81 Suppl 1:e93-e174